Updated: 4/1/2021

Narcolepsy

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Topic
Snapshot
  • A 17-year-old female presents complaining of an irresistible urge to sleep at sudden times throughout the day. This has disturbed her school functioning. She sometimes feels like she "is paralyzed" for several minutes when she wakes up.  She "passed out" one day at school when she was startled by her boyfriend.
Introduction
  • Pathophysiology
    • hypocretin deficiency in lateral hypothalamus (per DSM-V) 
  • Clinical definition
    • disordered regulation of sleep cycles
    • nocturnal and narcoleptic sleep episodes start off with REM sleep
    • patients cannot avoid falling asleep
  • Epidemiology
    • strong genetic component
    • typically onsets in young adulthood
Presentation
  • Symptoms
    • excessive daytime sleepiness
      • naps can be refreshing
    • may include hallucinations
      • hypnagogic
        • just before sleep
      • hypnopompic
        • just before awakening
    • cataplexy
      • loss of all muscle tone following a strong emotional stimulus
      • only some patients
    • sleep paralysis
      • short paralysis with awakening
Evaluation
  •  Polysomnography
Treatment
  •  Pharmacologic
    • modafinil is first line  
    • other stimulants e.g., methyphenidate (Ritalin), amphetamines may be limited by their adverse effects such as hypertension and anorexia
    • TCAs (e.g., clomipramine)
      • if severe cataplexy is present
      • may be limited by their anticholinergic effects
  • Sleep regulation
    • scheduled daily naps
    • avoid sleep deprivation or long naps

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(M2.PY.16.4684) A 21-year-old man presents to the clinic complaining of feeling tired during the day. He is concerned as his grades in school have worsened and he does not want to lose his scholarship. Upon further questioning, the patient describes frequently experiencing a dreamlike state before falling asleep and after waking up. He also has frequent nighttime awakenings where he finds himself unable to move. He denies snoring. The patient does not drink alcohol or abuse any other drugs. The patient's BMI is 21 kg/m2, and his vital signs are all within normal limits. What is this patient's diagnosis?

QID: 107310
1

Insomnia

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(0/10)

2

Obstructive sleep apnea (OSA)

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(0/10)

3

Delayed sleep phase syndrome (DSPS)

40%

(4/10)

4

Narcolepsy

60%

(6/10)

5

Alcohol withdrawal

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(0/10)

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